5610692 PAIN BURDEN PREDICTS EXECUTIVE FUNCTION IN PAEDIATRIC PATIENTS WITH SICKLE CELL DISEASE
Authors: Y. Chen, A.M. Hood, M. Kölbel, H. Stotesbury, J. Kawadler, A. Slee, B. Inusa, M. Pelidis, J. Howard, S. Chakravorty, S. Height, M. Awogbade, F.J. Kirkham, C. Liossi
Journal: HemaSphere (2023)

Background: Pain is a significant complication of sickle cell disease (SCD), including persistent and acute pain (often caused by vaso-occlusive crises). Chronic and persistent pain is associated with significant adverse effects on physical, emotional, social, and cognitive functioning. In terms of cognitive function, executive function (EF) is a domain where children with SCD experience the most profound difficulties. However, little is known about the effects of persistent pain on EF in children with SCD. Aims: The current study aimed to assess whether persistent pain (pain burden) predicts EF in children with SCD after controlling for demographic and medical variables (i.e., age, sex assigned at birth, and hydroxyurea treatment status). Methods: Our study was a secondary analysis of baseline assessment data of children with SCD aged 8–15 years (n = 30; 60% boys) in the Prevention of Morbidity in Sickle Cell Anaemia Phase 2b (POMSb2) randomised controlled clinical trial of auto-adjusting continuous positive airways pressure. Caregivers provided demographic information and reported on their child’s EF using the Behavioural Rating Inventory of Executive Function (BRIEF). The Global Executive Composite (GEC), Behavioural Rating Index (BRI), and Meta-cognition (MI) scales were used in our analyses. Higher T-scores (>65) indicate clinical concern (i.e., greater executive dysfunction). Children reported pain burden (Sickle Cell Pain Burden Inventory-Youth; SCPBI-Y) each month over eight visits. Results: Three hierarchical linear regression analyses were conducted. For our first regression analysis with BRIEF GEC as the dependent variable, the overall model was not significant (p =.17); however, pain burden was a significant predictor of the BRIEF GEC, t(23) = 2.36, p =.03, η2 =.19. For our second regression analysis with BRIEF BRI as the dependent variable, the overall model was not significant (p =.15); nevertheless, hydroxyurea treatment status t(23) = -2.11, p =.04, η2 =.16 and pain burden t(23) = 2.12, p =.04, η2 =.16 were significant predictors of the BRIEF BRI. Finally, for our third regression analysis with BRIEF MI as the dependent variable, the overall model was not significant (p =.30); however, pain burden was a significant predictor of the BRIEF MI, t(23) = 2.14, p =.04, η2 =.17. Summary: Our results demonstrate that higher pain burden significantly predicted worse EF in children with SCD with large effects. Our findings indicate that persistent pain adversely impacts behavioural and cognitive self-management EF skills. Additionally, hydroxyurea treatment status was a significant predictor of behavioural regulation. These data emphasise the significance of pain measurement before cognitive assessment and the potential role of medical treatments, such as hydroxyurea, in reducing EF dysfunction. Future development of cognitive interventions for children with SCD should consider including these critical factors in clinical trials. Reference 1. Hood et al, Frontiers in Psychology 2021;3976